Low physical activity and obesity: causes of chronic disease or simply predictors

. Background and Purpose: Many studies have shown associations between risk of morbidity and mortality with both obesity and low physical activity (PA), but association does not imply causality. Moreover, there is an inverse relationship between PA and obesity; therefore, controlling for one of these factors when investigating the risk associated with the other is essential. The purpose of this review is to determine whether low PA and obesity actually cause metabolic dysfunction and chronic disease, especially type 2 diabetes (T2D), rather than simply operating as predictors or markers. Methods: The case for causality is strengthened if the following two conditions are satisfied: first, that significant associations between obesity or low PA and risk persist after controlling appropriately; and second, that the physiological mechanisms by which obesity or low PA may exert a causal effect are clearly established. The studies examined include those that have used cardiorespiratory (CR) fitness as a surrogate measure for PA, thus also providing evidence for low CR fitness as an independent risk factor in its own right. Results and Conclusions: Low PA and poor CR fitness are independent predictors of mortality related to type 2 diabetes and chronic disease in general. Together with welldemonstrated mechanisms, there is strong evidence that low PA and low CR fitness are direct, independent causes of metabolic dysfunction and type 2 diabetes. Despite some reports to the contrary, there is evidence that both general and visceral obesity are predictors of mortality and morbidity after controlling for PA. However, in the absence of established mechanisms, evidence is insufficient to conclude that either general or visceral obesity is a direct, independent cause of metabolic dysfunction or type 2 diabetes

Determinants of Childhood Adiposity: Evidence from the Australian LOOK Study

BACKGROUND To contribute to the current debate as to the relative influences of dietary intake and physical activity on the development of adiposity in community-based children. METHODS Participants were 734 boys and girls measured at age 8, 10 and 12 years for percent body fat (dual emission x-ray absorptiometry), physical activity (pedometers, accelerometers); and dietary intake (1 and 2-day records), with assessments of pubertal development and socioeconomic status. RESULTS Cross-sectional relationships revealed that boys and girls with higher percent body fat were less physically active, both in terms of steps per day and moderate and vigorous physical activity (both sexes p<0.001 for both measures). However, fatter children did not consume more energy, fat, carbohydrate or sugar; boys with higher percent body fat actually consumed less carbohydrate (p = 0.01) and energy (p = 0.05). Longitudinal analysis (combined data from both sexes) was weaker, but supported the cross-sectional findings, showing that children who reduced their PA over the four years increased their percent body fat (p = 0.04). Relationships in the 8 year-olds and also in the leanest quartile of all children, where adiposity-related underreporting was unlikely, were consistent with those of the whole group, indicating that underreporting did not influence our findings. CONCLUSIONS These data provide support for the premise that physical activity is the main source of variation in the percent body fat of healthy community-based Australian children. General community strategies involving dietary intake and physical activity to combat childhood obesity may benefit by making physical activity the foremost focus of attention.The financial support provided by the Commonwealth Education Trust (London, UK) was vital to the completion of this work, and the authors thank the Board of Trustees for supporting them over several years. The authors also thank members of The Canberra Hospital Salaried Staff Specialists Private Practice Fund for their financial contribution to the study. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Longitudinal patterns of physical activity in children aged 8 to 12 years: the LOOK study

BACKGROUND Data on longitudinal monitoring of daily physical activity (PA) patterns in youth over successive years is scarce but may provide valuable information for intervention strategies aiming to promote PA. METHODS Participants were 853 children (starting age ~8 years) recruited from 29 Australian elementary schools. Pedometers were worn for a 7-day period each year over 5 consecutive years to assess PA volume (steps per day) and accelerometers were worn concurrently in the final 2 years to assess PA volume (accelerometer counts (AC) per day), moderate and vigorous PA (MVPA), light PA (LPA) and sedentary time (SED). A general linear mixed model was used to examine daily and yearly patterns. RESULTS A consistent daily pattern of pedometer step counts, AC, MVPA and LPA emerged during each year, characterised by increases on school days from Monday to Friday followed by a decrease on the weekend. Friday was the most active and Sunday the least active day. The percentage of girls and boys meeting international recommendations of 11,000 and 13,000 steps/day respectively on a Monday, Friday and Sunday were 36%, 50%, 21% for boys and 35%, 45%, 18% for girls. The equivalent percentages meeting the recommended MVPA of >60 min/day on these days were 29%, 39%, 16% for boys and 15%, 21%, 10% for girls. Over the 5 years, boys were more active than girls (mean steps/day of 10,506 vs 8,750; p<0.001) and spent more time in MVPA (mean of 42.8 vs 31.1 min/day; p<0.001). Although there was little evidence of any upward or downward trend in steps/day from age 8 to 12 years, there was a trend toward lower MVPA, LPA and a corresponding increase in SED from age 11 to 12 years. CONCLUSION A weekly pattern of PA occurred in children as young as age 8 on a day by day basis; these patterns persisting through to age 12. In addition to supporting previous evidence of insufficient PA in children, our data, in identifying the level and incidence of insufficiency on each day of the week, may assist in the development of more specific strategies to increase PA in community based children

Longitudinal patterns of physical activity in children aged 8 to 12 years: The LOOK study

BACKGROUND: Data on longitudinal monitoring of daily physical activity (PA) patterns in youth over successive years is scarce but may provide valuable information for intervention strategies aiming to promote PA. METHODS: Participants were 853 children (starting age ~8 years) recruited from 29 Australian elementary schools. Pedometers were worn for a 7-day period each year over 5 consecutive years to assess PA volume (steps per day) and accelerometers were worn concurrently in the final 2 years to assess PA volume (accelerometer counts (AC) per day), moderate and vigorous PA (MVPA), light PA (LPA) and sedentary time (SED). A general linear mixed model was used to examine daily and yearly patterns. RESULTS: A consistent daily pattern of pedometer step counts, AC, MVPA and LPA emerged during each year, characterised by increases on school days from Monday to Friday followed by a decrease on the weekend. Friday was the most active and Sunday the least active day. The percentage of girls and boys meeting international recommendations of 11,000 and 13,000 steps/day respectively on a Monday, Friday and Sunday were 36%, 50%, 21% for boys and 35%, 45%, 18% for girls. The equivalent percentages meeting the recommended MVPA of >60 min/day on these days were 29%, 39%, 16% for boys and 15%, 21%, 10% for girls. Over the 5 years, boys were more active than girls (mean steps/day of 10,506 vs 8,750; p<0.001) and spent more time in MVPA (mean of 42.8 vs 31.1 min/day; p<0.001). Although there was little evidence of any upward or downward trend in steps/day from age 8 to 12 years, there was a trend toward lower MVPA, LPA and a corresponding increase in SED from age 11 to 12 years. CONCLUSION: A weekly pattern of PA occurred in children as young as age 8 on a day by day basis; these patterns persisting through to age 12. In addition to supporting previous evidence of insufficient PA in children, our data, in identifying the level and incidence of insufficiency on each day of the week, may assist in the development of more specific strategies to increase PA in community based children

Physical Education and Blood Lipid Concentrations in Children: The LOOK Randomized Cluster Trial

BACKGROUND AND OBJECTIVES Elevated blood lipids during childhood are predictive of dyslipidemia in adults. Although obese and inactive children have elevated values, any potentially protective role of elementary school physical education is unknown. Our objective was to determine the effect of a modern elementary school physical education (PE) program on the blood lipid concentrations in community-based children. METHODS In this cluster-randomized controlled trial, 708 healthy children (8.1±0.3 years, 367 boys) in 29 schools were allocated to either a 4-year intervention program of specialist-taught PE (13 schools) or to a control group of the currently practiced PE conducted by generalist classroom teachers. Fasting blood lipids were measured at ages 8, 10, and 12 years and intervention and control class activities were recorded. RESULTS Intervention classes included more fitness work and more moderate and vigorous physical activity than control classes (both p3.36mmol.L(-1),130 mg/dL) was lower in the intervention than control group (14% vs. 23%, p = 0.02). There was also an intervention effect on mean LDL-C across all boys (reduction of 9.6% for intervention v 2.8% control, p = 0.02), but not girls (p = 0.2). The intervention effect on total cholesterol mirrored LDL-C, but there were no detectable 4-year intervention effects on high-density lipoprotein cholesterol or triglycerides. CONCLUSIONS The PE program delivered by specialist teachers over four years in elementary school reduced the incidence of elevated LDL-C in boys and girls, and provides a means by which early preventative practices can be offered to all children. TRIAL REGISTRATION Australia New Zealand Clinical Trial Registry ANZRN12612000027819 https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=347799.Sources of funding were The Commonwealth Education Trust (New Zealand House, London, UK) (http://www.commonwealth.org.uk/) and the Canberra Hospital Salaried Staff Specialists Fund (http://healthresearch.anu.edu.au/documents/PPFVACATION/ppf-major-info-2012.pdf). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Effects of Changes in Adiposity and Physical Activity on Preadolescent Insulin Resistance: The Australian LOOK Longitudinal Study

BACKGROUND In a previous longitudinal analysis of our cohort as 8 to 10 year-olds, insulin resistance (IR) increased with age, but was not modified by changes in percent body fat (%BF), and was only responsive to changes in physical activity (PA) in boys. We aimed to determine whether these responses persisted as the children approached adolescence. METHODS In this prospective cohort study, 256 boys and 278 girls were assessed at ages 8, 10 and 12 years for fasting blood glucose and insulin, %BF (dual energy X-ray absorptiometry); PA (7-day pedometers), fitness (multistage run); and pubertal development (Tanner stage). RESULTS From age 8 to 12 years, the median homeostatic model of IR (HOMA-IR) doubled in boys and increased 250% in girls. By age 12, 23% of boys and 31% of girls had elevated IR, as indicated by HOMA-IR greater than 3. Longitudinal relationships, with important adjustments for covariates body weight, PA, %BF, Tanner score and socioeconomic status showed that, on average, for every 1 unit reduction of %BF, HOMA-IR was lowered by 2.2% (95% CI 0.04-4) in girls and 1.6% (95% CI 0-3.2) in boys. Furthermore, in boys but not girls, HOMA-IR was decreased by 3.5% (95%CI 0.5-6.5) if PA was increased by 2100 steps/day. CONCLUSION Evidence that a quarter of our apparently healthy 12 year-old Australians possessed elevated IR suggests that community-based education and prevention strategies may be warranted. Responsiveness of IR to changes in %BF in both sexes during late preadolescence and to changes in PA in the boys provides a specific basis for targeting elevated IR. That body weight was a strong covariate of IR, independent of %BF, points to the importance of adjusting for weight in correctly assessing these relationships in growing children.Financial support was provided by the Commonwealth Education Trust (London, UK), the Board of Trustees and The Canberra Hospital Salaried Staff Specialists Private Practice Fund. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Outcomes of a four-year specialist-taught physical education program on physical activity: a cluster randomized controlled trial, the LOOK study

BackgroundThe objective of this study was to investigate the effect of a 4-year specialist-taught Physical Education (PE) program on physical activity (PA) among primary school children.MethodsA 4-year cluster randomised controlled trial was conducted in children (initially aged 8 years) from 29 primary schools (13 Intervention, 16 Control). Intervention students (N&thinsp;=&thinsp;457) received 2&thinsp;&times;&thinsp;45 min PE lessons per week from specialist-trained PE teachers (68 lessons per year, 272 lessons over 4 years). Control group students (N&thinsp;=&thinsp;396) received usual practice PE from generalist classroom teachers. PA during PE lessons was examined using the System for Observing Fitness Instruction Time (SOFIT). Pedometers (steps/day) were worn for 7 days each year, and accelerometers were worn concurrently in the final two years to assess moderate to vigorous (MVPA) and sedentary activity. Linear and generalized mixed models were used to determine differences in Intervention and Control student PA and the proportion of students meeting PA guidelines.ResultsThe intervention increased SOFIT-observed student MVPA during PE lessons by 6.5 mins (16.7 v 10.2, p&thinsp;&lt;&thinsp;0.001). Within intervention schools, participants increased their whole-day step counts (boys&thinsp;=&thinsp;449 [CI,140 to 756]; girls&thinsp;=&thinsp;424 [CI,222 to 626]) and minutes of MVPA (boys&thinsp;=&thinsp;8.0 [CI,6.8 to 9.2]; girls&thinsp;=&thinsp;3.5 [CI,1.7 to 5.4]) on PE days. However, compared to the Control group the Intervention did not: increase habitual steps/day or MVPA when averaged over 7 days; elicit greater improvements in these measures over time; or increase the odds of meeting step/day or MVPA recommendations. At age 11 years Intervention group boys were 20 mins less sedentary per day (380 [CI,369 to 391] vs 360 [CI,350 to 369]) and this effect was sustained at age 12 years.ConclusionsWell-designed specialist-taught PE can improve student PA during PE lessons. However for PE to be a significant contributor to improving habitual PA in pre-adolescent children, daily classes are likely to be required, and even this would need to be supplemented with a wider multicomponent strategy. Our finding of a reduction in sedentary time among Intervention boys warrants further investigation into the potential role PE could play in influencing sedentary behaviour.<br /

On the Inadequacy of Species Distribution Models for Modelling the Spread of SARS-CoV-2: Response to Araújo and Naimi

The ongoing pandemic of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is causing significant damage to public health and economic livelihoods, and is putting significant strains on healthcare services globally. This unfolding emergency has prompted the preparation and dissemination of the article “Spread of SARS-CoV-2 Coronavirus likely to be constrained by climate” by Araújo and Naimi (2020). The authors present the results of an ensemble forecast made from a suite of species distribution models (SDMs), where they attempt to predict the suitability of the climate for the spread of SARS-CoV-2 over the coming months. They argue that climate is likely to be a primary regulator for the spread of the infection and that people in warm-temperate and cold climates are more vulnerable than those in tropical and arid climates. A central finding of their study is that the possibility of a synchronous global pandemic of SARS-CoV-2 is unlikely. Whilst we understand that the motivations behind producing such work are grounded in trying to be helpful, we demonstrate here that there are clear conceptual and methodological deficiencies with their study that render their results and conclusions invalid. What follows is a response to the Araújo and Naimi article centered around three main criticisms: 1) Given the fact that SARS-CoV-2 has a primary infection pathway of direct contact, it is in an active spreading phase, and remains largely underreported in the Global South, it represents an inappropriate system for analysis using the SDM framework. 2) Even if we were to accept that an SDM framework would be applicable here, the methodology presented in the article strays far from best-practice guidelines for the application of SDMs. 3) The dissemination strategy of the authors failed to respect the frameworks of risks adhered to in other academic disciplines pertaining to public health, resulting in erroneous but well-publicised claims with broad policy implications before any scientific oversight could be applied

Isostructurality of quinoxaline crystal phases: The interplay of weak hydrogen bonds and halogen bonding

YesTailoring the physical properties of molecular crystals though the construction of solid solutions requires the existence of isostructural crystals. Simple substitutions of a given molecular framework can give a range of different crystal structures. A set of quinoxaline derivatives, C8H4N2(C6H4X)2,Q3,3′X2, has been investigated (X = F, Cl, Br, I and Me) where kinetic factors generated a set of isostructural crystals for the lighter halogens (F, Cl, Br) alone. Computational analysis shows that the stabilising interactions are maximal for Cl, while DSC studies demonstrate the existence of more stable polymorphs for both F and Br containing systems. Steric factors appear to have a lower contribution than the balance of weaker hydrogen and halogen bonding shown by the Me and I containing systems displaying different packing driven by CH⋯N/CH⋯π bonds and I⋯I bonds respectively

Do self-reported stress and depressive symptoms effect endothelial function in healthy youth? The LOOK longitudinal study

Background and aims: Endothelial dysfunction is thought to be an early indicator of risk for cardiovascular disease and has been associated with both stress and depression in adults and adolescents. Less is known of these relationships in younger populations, where the origins of CVD is thought to manifest. This study examined the effects of questionnaire derived psychosocial stress and depressive symptoms on endothelial function among children, following them through to adolescence. Method: Participants were 203 grade 2 children (111 girls; M age = 7.6 ± 0.3 years) from the LOOK longitudinal study, who were followed through to adolescence (16 years). Self-reported psychosocial stress and depression were assessed using the validated Children’s Stress Questionnaire and a modified and validated version of the Children’s Depression Inventory respectively; endothelial function was assessed using EndoPAT 2000 system at follow-up only; and adjustments were made for fitness, pubertal development and socioeconomic status. Results: Although all relationships occurred in the hypothesised direction, no cross-sectional or prospective evidence of early symptoms of psychological stress or depression being associated with endothelial dysfunction was found among our asymptomatic cohort of adolescents (all p > .05). Conclusions: In contrast to previous findings in adolescents, our data provided little evidence of any relationship between current or previous psychosocial stress or depression and endothelial function in 16-year-old boys and girls. However, our data need to be interpreted alongside the potential limitations in the sensitivity associated with self-report methods for detecting psychological distress of children.Support for this research was provided via a co-funded National Heart Foundation of Australia (https://www.heartfoundation.org.au)/ National Health and Medical Research Council (https://www.nhmrc.gov.au) Postgraduate Scholarship [GNT1056551] awarded to LO; an Australian Research Council Linkage Grant to DB; and from The Commonwealth Education Trust (New Zealand House, London, UK); (http://www. commonwealth.org.uk/) awarded to DT. Adolescent work was funded by the Canberra Hospital Salaried Staff Specialists Fund awarded to W